CAJ | 학술논문

目的：总结经右胸骨旁小切口手术治疗继发孔型房间隔缺损的经验和疗效。方法回顾性分析2013年7月至2014年8月作者收治的经心脏彩超检查确定适合采取封堵手术治疗的房间隔缺损患儿24例，其中男性10例，女性14例，年龄1岁3个月至6岁，年龄3岁以下15例，6岁以上9例。缺损最长径5～19（10．0±4．5）mm。做右胸骨旁1～2．5（1．7±0．6）cm 切口，放入切口保护套和（或）小型切口牵开器，切开心包，在食管超声心动图（TEE）监视下经输送鞘置入封堵器。结果24例均成功封堵，无一例中转开胸手术，手术时间30～90（43±19）min，术中出血量2～140（21±34）mL。术后出现快慢型房性心律失常1例。术后住院2～9（4．7±1．8）d。出院前复查心脏彩超未见残余分流，无明显胸腔积液。术后3个月随访心脏彩超13例，封堵器无残余分流。结论右胸骨旁小切口封堵手术治疗继发孔型房间隔缺损操作简单，安全有效，切口小，恢复快、并发症少，近期效果满意，适合于年龄3岁以下继发孔型房间隔缺损患儿。
목적：총결경우흉골방소절구수술치료계발공형방간격결손적경험화료효。방법회고성분석2013년7월지2014년8월작자수치적경심장채초검사학정괄합채취봉도수술치료적방간격결손환인24례，기중남성10례，녀성14례，년령1세3개월지6세，년령3세이하15례，6세이상9례。결손최장경5～19（10．0±4．5）mm。주우흉골방1～2．5（1．7±0．6）cm 절구，방입절구보호투화（혹）소형절구견개기，절개심포，재식관초성심동도（TEE）감시하경수송초치입봉도기。결과24례균성공봉도，무일례중전개흉수술，수술시간30～90（43±19）min，술중출혈량2～140（21±34）mL。술후출현쾌만형방성심률실상1례。술후주원2～9（4．7±1．8）d。출원전복사심장채초미견잔여분류，무명현흉강적액。술후3개월수방심장채초13례，봉도기무잔여분류。결론우흉골방소절구봉도수술치료계발공형방간격결손조작간단，안전유효，절구소，회복쾌、병발증소，근기효과만의，괄합우년령3세이하계발공형방간격결손환인。
Objetive To summarize the clinical experience and key technology of minimally Invasive transthoracic closure of atriall septal defects in children.Methods From July 2013 to August 2014,A total of 24 patients with atrial septal defects,with mean age of (3.3 ±1 .5)years(from 1 .25 years to 6 years)and mean weight of (13.0 ±3.5)kg(from 8.5 kg to 22.0 kg).The diameter of their ASD ranged from 5 to 19 mm (10.0 ±4.5 mm).A small transthoracic incision (from 1 .0 to 2.5 cm)transverse incision in the third inter-costal space was made.The delivery pathway was established under TEE guidance,proper devices were deliv-ered and then deployed to close the defect.Results 24 cases received the occulusioin successfully.The time for the occusion was 30 to 90 minutes with a mean of (43.2 ±19.5)min.The amount of intraoperative blood loss was 2 to 140 mL with a mean of (21 .5 ±34.3)mL.The arrhythmia occurred in 1 patient.The patients were discharged from 4 to 9 days with a mean of (4.7 ±1 .8)days.No dislocation of the device was found in 3 months after the operation.NO patient Was convert to open surgery because of failure in the occlusion.Con-clusions Minimally Invasive transthoracic closure of atrial septal defedts is safe,effective and easy to handle. The long-term follow-up remains to be studied.